What type of midwife did you/do you have?

[liberal_chick]

My dh and I are getting ready to TTC our 2nd baby. I had a horrible pregnancy with ds and he ended up being delivered via c-section at 30 weeks. Even though there were other complications, the c-section was due to his breech presentation.

I've done a ton of reading and researching and have turned dh's "hell no we will never have a homebirth" into a "homebirth is the way to go."

However, he will only agree (at this point, I still have time to work on him) if we have a CNM. No other type of midwife will do; he wants someone who has been to nursing school. Unless I can convice a CNM to do my birth "under the radar," it is doubtful I will be able to find one to attend me. (Arkansas law dictates that licensed midwives cannot attend VBACs or women with a peviously premature baby.)

So, tell me what type of midwife you had. Did you think, if she wasn't a CNM, that she lacked something in any way? Dh is really worried that, if something emergent was to happen, anyone other than a CNM would miss the signs and I would die. While I appreciate that he cares for me so, I think he's silly.

[J's Mama]

My midwife actually was a CNM but I would have been perfectly comfortable with a direct-entry midwife. I would safely say that any lay midwife with substantial experience will know if intervention is needed. Maybe when you find some midwives to interivew, make sure your husband feels comfortable asking his questions about her experience and/or training. It's not rude to ask questions and feel sure about your practicioner. Good luck with your search!

[SusannahM]

Mine were CPMs. They're legal in Texas, and have to go through years of apprenticeship and lots of training, then pass a hard test. I felt completely comfortable that they would catch anything that could possibly happen. The midwife for my youngest had attended about 1300 births, I thought that counted for a lot more than the letters after her name.

[sunnymw]

Mine is a DEM with 15 years apprenticeship + experience. I would be MORE inclined to trust someone with hands-on experience than with just book-learned experience... they have a wider range of what they consider "normal" and know how to handle unusual things better...

[janasmama]

I had a CNM with my dd1 and a CPM, LM with my ds2. The CNM has 10 years exp in L&D and 15 years experience doing homebirths.

My CPM didn't have quite as much time under her belt and I didn't notice any difference in their answers to my questions, their attention to the birth or any other thing that would have been noticeable. I was completely comfortable.

Definitely take a look at the interview questions sticky at the top of this forum.

[srlpenny]

I am working with 3 CPMs (one now also a CM, which allows her to have a NY State License) they have varying levels of experience and strengths, but all have made me feel very confident in the abilities.
My DH was originally exactly where yours is, but there is NO CNM that does homebirths in our area, so that wasn't a choice.
One thing I though was very helpful in convincing him was the British Medical Journal study, which was done exclusively with CPMs, not CNMs and still found homebirth to be at least as safe. http://www.bmj.com/cgi/content/full/330/7505/1416?ehom
I'm not sure how VBAC would play into it, if at all. If you can get him to agree to interview midwives, then maybe them demonstrating their competency in teh interview will help allay his fears.

[Danielle13]

I had a CDM. I wouldn't have a CNM.

Danielle*

[~Megan~]

It depends on the person not the credentials, IMO.

We had a liscenced midwife and she was just the kind of provider that I wanted.

I think CNMs can be more medwives than non CNMs. It does vary though.

[Red Sonja]

A LM attended DD's birth and will attend the birth of the new babe as well.

I had a CNM at DS' birth (a hospital birth). She was in a practice with an OB and another CNM, and when it came down to it I didn't see a difference between her and the OB. I decided it would be in my best interest to find a different type of midwife for my subsequent births, even though it meant paying out of pocket since my insurance only covers CNMs.

[alegna]

With dd I started with a CNM. After she dumped me at 28 weeks, I switched to what is now called a licensed midwife in TX. BEST thing that happened all pregnancy. I felt MUCH safer with her. The CNM was all about fear. My current midwife is well educated, but much more confident (but in no way OVER-confident)

I trust her MUCH more in an emergency. And *more* importantly- I trust her to know what is and isn't an emergency.

-Angela

[crazydiamond]

Mines a LM/CPM. I don't have any bias against CNMs if I could find one that specializes in a homebirth. That's because my state makes homebirth perfectly legal and allows all 3 types to attend them.

I understand your DHs concern, I really do. I actually felt the same way when I was looking for a MW early in my pregnancy, but now I've changed my mind.

A MW is only as good as her experience. If a CNM only has experience with hospital births, then she is only good for hospital births. I would not feel comfortable with such an individual attending a homebrith, because the two are hugely dissimilar. An experienced CPM/LM, on the other hand, has probably only done homebirth or small birthing center births, in which case her experience would be much more valuable than the CNMs. If you can find a CNM that has most of her experience in doing homebirths and you like her, then I don't see a reason not to use her. I would evaluate each MW based on her personal experience and how much her philosophy fits yours instead of eliminating a whole category of them based on their credentials.

[starshine1001]

I had a LM/CPM. She was awesome!! I had been considering going to school to become a CNM (I'm an RN already), but decided that when I go back to school, it'll be to be a LM/CPM. CNM's are really tied down as far as legislation goes right now. But as for the question at hand, there are legalities that CNM's are tied to that LM/CNM's aren't. Therefore, you are more likely to find one that will attend you with your history. And it's really all about the person...her manner, her experience (education aside...I'm talking BABY experience!), her outlook. Midwives are all educated in symptoms of emergencies and how to deal with them, no matter what kind of midwife. The biggest difference is where and how they can practice, as defined by the law of the state they're in.

[BakerALM]

My current MW is a CPM with almost 30yrs experience and about 600 births. She keeps great records and was open with her all her stats and stories of complications and how she dealt with them which really made my hubby and I feel safe. Also she is anti intervention without true medical need which was a must for us! (hates inductions, has no cut off date for birth like 42wks or anything, owns a 3acer herb farm But the bottom line was we both feel comfortable with her medical knowledge, hands on experience and personalty.

Basically just have your husband go on interviews with you, after 2.5 hrs chatting with our MW at the interview he was a total HB convert, even saying if we had to pay out of pocket for the whole thing it would still be worth it . But before the interview he still was not completely on board.

[Pyrodjm]

I am using a CNM with 13 years experience. She is VERY laid back about medical testing and intervention (only test that have been done are ones I requested). Also very respectful of natural, normal birth. I would use her no matter what letters were after her name.

[optimism]

I'm using a CPM for this homebirth. In Wisconsin (where I am) CPM's can be licensed as medical professionals, and mine is. I can't say I WOULDN'T hire a CNM, it depends so much on the person. Hell, I'd be perfectly comfortable letting the OBGYN that was there for my first VBAC in the hospital come do my homebirth if she could - there are a lot of Midwives in Disguise (MD's) just as there are a lot of medwives. Seriously - I don't even know if she ever touched me - she stood there and made sure that the baby didn't fly out of me after the shoulders came, and then let me catch the baby and pull her up on my chest myself. She even let me massage my own uterus, which I have to say is a lot better than having somebody else pushing on it! I didn't specifically ask her (or have in my birthplan) either of these things - all she knew was that I wanted a med and intervention free natural birth, and she respected that better than I dreamed possible. Heck, she wasn't even my doctor, she was new to the practice and I'd only met her once.

I later found out that she got in trouble at her old practice somewhere out west for backing up homebirths! So, you really just never know.

You both need to meet the midwives, evaluate their experiences, ASK them about any/all transfers and if they've ever had a poor outcome. My CPM has a wealth of knowledge and I have absolutely zero anxiety about my upcoming HBAC. More importantly, neither does my husband, as he was the reason that ultimately I gave birth in a hospital last time - he just wasn't ready for a primary VBAC at home, what with my "unproven pelvis" (first baby did get stuck - was asynclitic OP baby).

[mbhf]

I have had CNMs for all of my births so far. One in the hospital and two at home. My HB MW was wonderful, I loved her and if I hadn't moved 800 miles away I would want her there again. This time we are working with a CPM. Honestly I would prefer a CNM just because they can write prescriptions, I wouldn't have to be "approved" for a homebirth by someone else, and they can have hospital privilages. Plus my insurance covers CNMs but not CPMs.

I think a Midwife's experience and general attitude about birth is much more important than her certification though.

[1babysmom]

My midwife is a direct entry midwife. I was hesitant about it at first just because I figured that she wouldn't know as much as other midwives, but that's totally untrue! It's all about the person and their experience. She's really great- 15+ years of attending births, plenty of experience in pretty much every situation, etc. AND, if she were licensed we wouldn't be able to afford her (our insurance won't cover homebirth/midwives in most situations, so it's MUCH cheaper to go to a hospital in that case).

I've heard that sometimes the best midwives are unlicensed ones (who choose to remain that way), but I forget the reasoning behind that statement... LOL

[prothyraia]

When I was looking for midwives for this pregnancy, I really wanted to find a CNM. I couldn't, so we're with a CPM. And she's really more knowledgable and competent than the CNM I had with my hospital birth. The CPM has been doing this for 30 years- I have the utmost confidence in her ability to handle anything that comes up.

If there is a medical problem, you're going to have to transfer anyway. An experienced, liscenced midwife is going to be just as good at identifying signs of a problem as a CNM (and possibly better at stabilizing you on the way to the hospital, as she might be more experienced with dealing with these situations without any technological/medical assistance other than what she has with her).

CNM are closer to being generalists. If your husband goes into anaphylaphitic shock or has a stroke while you're in labor, a CNM would have a better idea of what to do. When it comes to birth, though, there's only so many different complications that can happen, and all that "extra" medical knowledge doesn't necessarilly apply.

I highly reccommend that you and your husband go talk with some experienced midwives. Nothing is more likely to make him comfortable with the idea than being exposed to them in person- an experienced midwife will be used to setting nervous husbands at ease ; )

There's also a homebirth study about homebirth's with CPM's that showed fantastic outcomes...I'll try to find it.

Edited to add: Here's a link: http://www.mana.org/CPM2000.html

[Peony]

I started off with a RM, which is what my states has instead of CPM. She was very medically minded, we were quickly butting head about me refusing things, like the glucose screening. I went to a CNM instead who had been a MW for over 20y and was so laid back that it was a breath of fresh air. The RM was a good MW, she just was not the MW for me.

[ThreeBeans]

Mine was a DEM. CNMs are not legally allowed to attend homebirths in my state.

She was competent and brilliant and I would recommend her a thousand times over